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P - 80007' REQUEST FOR ELECTRICAL INSPECTION Minnesola Board of Eiectricity �� 1-396-117 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800-627-3529 www. electricify, s ta te. mn, us Identify the work covered by this request: LIREW ❑ REMODEL ❑ ADQITION ❑ REPAIF 0 to 400 ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAIING CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Unit � $25 OTHER ADDITIONAL FEES � $.25 per Fixture �atio� Boom � $4� XCEL ENEROY SAVER'S SWITCH to 10 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit �$8o Additional Insoection Trios � $20 � � i nareoy oenny ma� i R011GH IN FlNALINSPECT�ON TOTAL FEE total fee is $20) DATE DATE FOR OFFICE USE ONLY 1 II�III IIIII II�� I��� I��I ����� * 1 3961 1 72* ��� 0�0 S� Reque��ro2 Rough-in Inspection Required? ❑ Yes I�No InspecNon Other Than Rough-in: � Ready Now ❑ Will Cell You musl cali the inspector when ready! Date Ready: I certity that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requesl inspection of the electrical work at: Jab Addressl$t�@� Bo�OL �qyt� plq�. C�H FRIDLEY �p �8 �J'�32 61 esu � ri b � irt Section Township Range Fire No. County ai�{(a ooc��UDLEY EOANIN F 2 9��� Phona Power Supplier Address XCEL ENERGY ElectricaH�nh,gct r�y� a��,r�� Contractor Lice� N�mb_ r3 Master License Number 4V 4 1 �1Unn MaiGng 9� E�S 1 CKI'{I I LR[IPI�y��� PJNi141 �-*q I ti MH �i� i� ��itlp Authoriz nature (C�pt� � ompany or Owner Perfortning Installation) Phone g51 848-2911 �4oR� E8-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW CAPY